What can provoke placental abruption. Placental abruption at different stages of pregnancy

Placental abruption is a serious diagnosis that complicates the course of pregnancy and directly threatens its favorable outcome. Is it possible to prevent this condition and what to do if the detachment still occurs?

It is not for nothing that the placenta is called a "child's place", because it is formed and functions exclusively in the interests of the unborn child. This unique organ appears in the body of a pregnant woman shortly after conception, and throughout pregnancy is a link between the mother and her unborn baby. The main tasks of the placenta include:

1. Providing the fetus with nutrition and oxygen. In fact, the placenta consists of a huge number of intertwined vessels, through which the blood of the mother and the fetus she is carrying is constantly moving. It is from the mother's blood that the unborn child receives all the nutrition and oxygen he needs.
2. Removal of waste products of the fetus, which also occurs due to the close interaction of the blood vessels of the mother and the baby in the placenta.
3. Production of hormones. The placenta produces and releases into the mother's blood a huge amount of hormones that help maintain pregnancy and prepare a woman for childbirth and breastfeeding.
4. Protecting the fetus from unwanted environmental influences. As the placenta forms, a hematoplacental barrier forms in it - a kind of filter, thanks to which many unnecessary and even harmful substances from the mother's blood do not enter the child's blood.

Important: Despite the presence of the hematoplacental barrier, the placenta is not able to protect the baby from the harmful effects of nicotine, alcohol and narcotic substances, some drugs and viruses .

What is placental abruption

Nature stipulates that the placenta must perform its functions for the life support of the child until his birth. And only after the baby is born, the placenta spontaneously separates from the walls of the uterus and is born after it.

For a number of reasons, sometimes this algorithm fails, and the placenta is separated from the walls of the uterus even before the baby is born - in this case, we are talking about placental abruption.

Important: Untimely or premature placental abruption is diagnosed in about 1% of cases.

This pathology can overtake the expectant mother at any gestation period. But in the later stages of pregnancy, premature placental abruption is most dangerous, since the placenta no longer grows or develops at this time, which means that it will not be possible to compensate for the state of abruption in a natural way. Doctors have to save a child's life with an emergency caesarean section. Otherwise, the consequences can become unpredictable, up to and including death.

Important: Placental abruption is the main cause of intrauterine death, as it leads to the rapid development of acute oxygen deprivation in the fetus.

Why does placental abruption occur?

Scientists have not yet identified a single factor that would unequivocally lead to the occurrence of placental abruption in late pregnancy. But numerous studies have confirmed that the risk of developing this pathology increases in the following cases:

• high blood pressure in the expectant mother for a long time;
• trauma to the abdomen of a pregnant woman (as a result of an accident, accident);
• a diagnosed placental abruption in the past increases the likelihood of the same pathology occurring up to 25%;
• abnormalities of the uterus (eg, saddle shape);
• placental abnormalities (presentation, presence of additional lobules);
• pathology of blood clotting in a pregnant woman;
• past caesarean section;
• multiple pregnancy;
• post-term pregnancy;
• polyhydramnios;
• a large number of births;
• rapid childbirth;
• the age of the pregnant woman is over 34 years old;
• early and late toxicosis;
• autoimmune and chronic endocrine diseases (lupus, diabetes mellitus).

Important: With a combination of 2 or more factors, the risk of developing placental abruption increases many times. Such women should be especially careful about their health during pregnancy.

Detachment symptoms

Depending on where the detachment occurred and how extensive it is, the symptoms can be of varying severity. But the main signs of placental abruption in a pregnant woman are in any case:

• Uterine bleeding. It always occurs, since a detachment is a rupture of the connection between the placenta and the wall of the uterus, which is accompanied by bloody discharge. The bleeding is external in most cases, and a pregnant woman can detect it almost immediately.

Important: If any bloody discharge from the vagina is found, a pregnant woman should immediately consult a doctor.

In 20% of cases of placental abruption, there is no bloody discharge, since blood accumulates in the form of a hematoma between the placenta and the wall of the uterus. This is a very dangerous condition, since the growing hematoma presses on the placenta and thereby aggravates its detachment. In this case, the main symptoms of pathology will be

• Pain in the abdomen, palpable tension. With internal bleeding, a hematoma occurs, which gradually increases in size and begins to press on the wall of the uterus and peritoneum, irritating them and causing pain. If, at the same time, a pregnant woman also has a general malaise in the form of nausea, increasing weakness and dizziness, this is an alarming sign of possible internal bleeding. Seeing a doctor should be immediate!

On the part of the fetus, a symptom of placental abruption is a state of acute hypoxia or oxygen starvation. With a slight degree of hypoxia, the fetus begins to actively move. Thus, he "massages" the placenta in order to increase the flow of oxygen and nutrients. As the degree of oxygen starvation increases, the child's movements become more and more rare, and his cardiac activity is disrupted.

Important: If you suspect a placental abruption, it is imperative to conduct a cardiotocographic study to assess the health of the fetus.

Detachment of a third part from the entire area of ​​the placenta can lead to the death of the baby. With complete abruption of the placenta, intrauterine fetal death occurs almost instantly.

Diagnosis of placental abruption

This diagnosis rarely causes difficulties for doctors, since most often there are bloody discharge from the genital tract of a pregnant woman, abdominal pain and increased uterine tone, signs of oxygen starvation in the fetus.

Ultrasound diagnostics is necessary in order to classify placental abruption on the following grounds:

Basis for classification	Types of placental abruption	Forecast
Time of occurrence	Early (up to 20 weeks)	Favorable, 80% have delivery on time
	Late (after 20 weeks)	Unfavorable, delivery on time in 20%
	During childbirth	Adverse
Progression	Progressive	Adverse
	Non-progressive (the detachment has stopped)	Favorable
Square	Partial	Favorable with a detachment area of ​​less than 25%
	Full	Adverse
Localization	Marginal - the placenta is separated along the edge, uterine bleeding is pronounced	Favorable with a small area of ​​detachment
	Central - the placenta is separated in the central part, uterine bleeding may be absent	Adverse
Severity	Mild - minor symptoms, no hypoxia on the part of the fetus	Favorable for the fetus
	Moderate to moderate maternal and fetal symptoms	Favorable
	Severe - the mother's condition is severe, intrauterine fetal death	Adverse

Any bloody discharge, abdominal pain, pronounced uterine tone, a significant deterioration in the well-being of a pregnant woman and a change in fetal activity should alert the expectant mother. If you develop any of these symptoms, you should seek immediate medical attention. Self-medication during pregnancy can be simply criminal, since it is not only about the health of the woman herself, but also about the life of her unborn child.

In late pregnancy, especially if there are only a few weeks left before delivery, the onset of placental abruption is a direct indication for emergency delivery. In this case, this is the optimal outcome for the mother and child in order to avoid irreversible consequences for their health.

If placental abruption is insignificant and non-progressive, then doctors will try to create all conditions for a pregnant woman to report her baby. In this case, only inpatient treatment is necessary under the day and night supervision of doctors in compliance with strict bed rest. Monitoring the child's condition is carried out using Doppler and cardiotocography. Any negative changes in the condition of the mother or fetus may become an indication for an emergency caesarean section.

Important: Pregnant women who have been diagnosed with placental abruption in previous pregnancies should be in the hospital under the supervision of doctors from the 36th week of pregnancy, even in the absence of threatening symptoms.

The placenta is a completely unique organ that can only be found in the body of a pregnant woman. It is born with the child (10-15 minutes later than the fetus) and after that it is formed only during the next one. The placenta is popularly referred to as a "baby's place" because it serves as an inextricable link between mother and child. Breaking this connection is very dangerous for an unborn baby.

The placenta is an important and unique organ that only exists during pregnancy.

Some consider the placenta the entire shell in which the baby is inside. But this is not entirely true. The placenta is just a small section of the membrane adjacent to the back wall of the uterus. It provides a connection between the fetus and the mother's body. The rest of the shell is called the afterbirth.

The placenta has the shape of a disc, pierced by a mesh of blood vessels. Detachment of the placenta in the early stages leads to impaired blood circulation and oxygen metabolism in the body of the embryo, which can be dangerous not only for the life of the child, but also for the life of the mother.

The placenta in its final form is formed only by the 15th week, when the blood flow of the mother and the child is completely delimited.

Up to this point, the placenta does not yet have a clear structure. Until the 6th week, they speak only of the chorion, the rudimentary organ from which the placenta is then formed.

The placenta has several important functions:

• Breathing and gas exchange. It is through the placenta and the bloodstream that oxygen enters the fetus. Oxygen is actively supplied to the child, and carbon dioxide is removed.
• Excretion of waste products. Other substances from the child's body are also removed through the placenta.
• Nutrition. All nutrients, vitamins, minerals necessary for a growing body are delivered to the fetus through the placenta. Therefore, poor circulation in the placenta can lead to developmental delay.
• Development. The placenta activates the production of hormones necessary for the development of the fetus and to prepare for lactation.
• Child protection. Through the placenta, various supplies from the mother come to the fetus, which protect it from infection. The placenta also protects the fetus from the maternal immune system, which may recognize it as a threat.

It is worth remembering that in addition to nutrients through the placenta, harmful substances, toxins, nicotine, alcohol, drugs and infections enter the child's body. A pregnant woman should take care of herself and lead a healthy lifestyle, which will have a beneficial effect on the condition of the placenta and on the health of the unborn baby.

Causes of detachment of the placenta in the early stages

Placental abruption can occur at any stage of pregnancy and even during labor itself. At any time and in any situation, detachment of the placenta can be dangerous, therefore, medical attention and supervision is necessary.

Early pregnancy is considered to be up to 20 weeks. In this case, detachment can occur both at the 8th and at the 19th week. It is impossible to reliably determine the cause of what happened, since the causes of detachment have not been sufficiently studied.

However, there are certain most common causes of placental abruption:

• Numerous births. If the birth is not the first, the condition worsens, which is reflected in the placenta. It can age prematurely, causing detachment.
• Bad habits. Alcohol, smoking, fatty foods, taking medications without consulting a doctor can provoke poor circulation and placental abruption.
• Gestosis. In this condition, blood flow is disturbed, blood pressure rises. Placental vessels become more fragile, weak, which provokes detachment.
• Autoimmune diseases. With these, the human immune system responds inadequately to stimuli, recognizing the cells of its own body as foreign. The placenta and fetus can be affected in the same way.
• Intrauterine infection. Infection provokes many problems: from abnormalities in the development of the fetus to placental abruption and intrauterine death. Any infection that enters the body of a pregnant woman requires the attention of doctors and immediate treatment.
• Pathology of the uterus. In some cases, placental abruption can only be explained by pathological processes in the uterus. They are dangerous in that they are difficult to identify and prevent.
• Abdominal trauma. Injuries can occur during a fall, accident, blow to the abdomen. This can be dangerous for the baby and provoke placental abruption and premature birth.
• ... Some cardiovascular diseases, as well as chronic diseases, can lead to detachment.

Signs and diagnosis

Lower abdominal pain and spotting are signs of placental abruption

In the initial stages, placental abruption may be asymptomatic. It can only be detected when. The doctor determines the presence of a hematoma in the area of ​​attachment of the placenta.

If the placenta has moved slightly, then blood will accumulate between it and the uterus, and there will be no external bleeding. However, more often this phenomenon is accompanied by pain in the abdomen and tone of the uterus (tension, hard stomach).

The main symptoms of placental abruption in the early stages:

• Bloody vaginal discharge. Blood at any time frightens expectant mothers, they strive to see a doctor faster, and rightly so. If placental abruption occurs on the side of one edge, blood will come out, this is an alarming symptom that in no case should be ignored. With timely assistance, blood loss can be stopped and the pregnancy can be maintained. The most dangerous are internal bleeding, which can lead to the death of the mother and child.
• Stomach ache. They can occur with or without bleeding. Placental abruption is almost never complete without painful sensations. The pain can be of varying intensity, strong and constraining, or pulling and aching. In any case, the appearance of pain requires a visit to a doctor. Severe pain may indicate dangerous internal bleeding.
• Heart rhythm disturbances and oxygen deprivation. At a later date, expectant mothers note the active movement of the child or the absence of movement, but in the early stages such symptoms are impossible. Usually, the fetal heart rate is spoken of during a planned one. If violations are noted and the ultrasound shows signs of detachment, the pregnant woman is placed in a hospital for preservation.

Detachment is often referred to as symptoms, after which the doctor prescribes an ultrasound supplement for confirmation. It is very important to inform the doctor on time about what worries the pregnant woman and not to avoid hospital treatment. Also, if a detachment is suspected, the doctor will examine the patient in the chair to determine if the cervix has opened.

Treatment

Treatment is prescribed by a doctor according to the situation, depending on the condition of the fetus and the patient. Placental abruption has its own stages and characteristics. With a small detachment in the early stages and timely assistance, the prognosis is very favorable. The patient is prescribed drugs that relieve the tone of the uterus, vitamins, iron preparations, hemostatic agents. With proper treatment and the absence of serious pathologies, the placenta grows to the wall of the uterus due to an increase in its area with the course of pregnancy. In the future, pregnancy can proceed without complications if all the doctor's recommendations are followed. Such detachment is called partial and non-progressive.

If placental abruption is partial, but progresses, this condition of the patient is considered more dangerous. It is necessary to stop the growing hematoma and restore nutrition to the fetus. To do this, a pregnant woman is placed in a hospital, carefully observed, prescribed bed rest, various drugs to reduce the tone of the uterus and to ease blood loss. If no means can help, the hematoma grows, the question of urgent delivery arises. In the first trimester, the child, as a rule, dies, but with timely help, the mother can be saved.

Complete placental abruption is rare.

In this case, the supply of oxygen and nutrients to the fetus completely stops, it dies. The only possible treatment in this case is emergency delivery.Doctors may refuse to stimulate labor and try to preserve the pregnancy if the gestation period is short and the baby has little chance of surviving after childbirth, and if there are no signs that the detachment is progressing, blood loss is low, and there are no obvious signs of oxygen starvation in the fetus.

Useful video - Placenta during pregnancy.

To improve the condition, a woman is prescribed antispasmodic drugs (No-shpa, Drotaverin, Papaverine in the form of suppositories, Magnesia), hemostatic drugs (Vikasol in the form of tablets or Decinone injections), as well as iron preparations to prevent development.Under no circumstances should you try to treat a detachment at home without consulting your doctor. Without professional medical care, this condition can lead to the death of the mother and child.

Complications and prevention

Undoubtedly, the most terrible consequence of detachment is the death of the mother and child. Doctors are trying with all their might to prevent such an outcome. If it is impossible to save the child, the life of the mother must be saved.

There is nothing worse for a pregnant woman than losing a baby. This is the worst thing that can happen. And one of the reasons for this may be placental abruption. How to identify it in time, and what is needed to save the baby.

Placental abruption: what is it

The placenta, or baby's place, connects the mother and the baby, creating the most comfortable conditions for him, and therefore for intrauterine growth and development. Any break in this connection, even a small area or edge of the placenta, can harm the baby. Sometimes a minor injury in the form of a fall or a push into the abdomen is enough for a detachment to form, but still, in most cases, nature can protect the child from external mechanical influences. However, a problem may arise inside: with some vascular diseases or with complications of pregnancy, conditions arise in which detachment occurs spontaneously. This is a high, chronic inflammation of the genitals.

The most common causes of placental abruption are:

• trauma (car accident, fall on the stomach, blow to the stomach);
• short umbilical cord in the fetus;
• excessive stretching of the uterus (twins, excess amniotic fluid);
• diagnostic and therapeutic manipulations during pregnancy;
• improper use of drugs that change the tone of the uterus;
• tumors of the uterus (fibroids, endometriosis);
• hard physical labor;
• severe stressful situation (unexpected strong fright).

What is placental abruption

1. Small and not growing in size

With this option, the baby has every chance to calmly endure the inconveniences associated with a lack of nutrients and oxygen. And the placenta will be able to gradually restore the connection with the wall of the uterus. But a favorable outcome will be only with correct and timely treatment in a hospital.

2. Partial and gradually increasing in size

In this case, the risk to the fetus is very high. An increase in the degree of detachment leads to the fact that the baby receives fewer substances necessary for life, which can cause severe suffering in the child.

3. Complete abruption of the placenta

And with this version of detachment of the child's place, the count goes on for minutes. A complete break in the connection between mother and baby becomes the cause of the rapid death of the fetus.

To predict the life of the fetus, not only the degree of detachment is important, but also factors such as the duration of pregnancy and the location of the placenta. Detachment with placenta previa is much more dangerous, and with a short pregnancy, even with an urgent operation, it is impossible to save an unviable fetus.

How will the detachment of the child's place manifest

1. Pain

The first thing that arises is pain in the abdomen above the bosom. Even if they are not very pronounced, a woman should suspect something was wrong and consult a doctor. Especially if the pain persists or increases. The pain syndrome with detachment occurs due to an increase in the tone of the uterus, and it is no less dangerous for the baby than the separation of a part of the child's seat. With hypertonicity, blood vessels are compressed, and the body of the crumbs immediately begins to experience oxygen hunger.

2. Bleeding

Any blood that comes out of the vagina is a sign of an impending condition. We need to be in the hospital in the near future. Even if it is a threat of premature termination of pregnancy, and not placental abruption. In any case, if there is bleeding, you must rush to the hospital. Blood loss is also dangerous for the expectant mother.

3. Change in fetal movements

By the movements of the fetus, a woman can always find out if the baby is good. Moreover, if the fetus is very actively moving, then this does not mean at all that the child has enough. Hyperactivity may indicate anxiety in the fetus, which is experiencing a marked lack of oxygen. And a decrease in the number of perturbations can be a sign of serious problems with providing for the baby. In any case, in case of unexpected changes in fetal movements, it is better to consult a doctor.

The diagnosis of detachment is not difficult: it is enough to do an ultrasound of the uterus to determine its exact location and size. And dopplerometry will show how seriously the blood flow in the affected area of ​​the child's place is disturbed, whether the bleeding continues or a blood clot is already forming.

What to do with placental abruption

As scary as it may seem, it is impossible to remain inactive when symptoms of placental abruption occur: the woman has little time to manage to save the baby. And in no case should he hesitate. With minimal manifestations, if you cannot get to the doctor on the next day, you must yourself go to the hospital. In the event of a decrease in fetal movements or when blood appears from the vagina, you need to call an ambulance and go to the hospital. With placental abruption, all possible help can be obtained only in an obstetric hospital.

The degree of detachment is of great importance for the provision of assistance:

• with a small and not progressive detachment, timely assistance to a baby suffering from a lack of oxygen will ensure the preservation of pregnancy and the maturity of the fetus;
• with partial and increasing detachment, you must very quickly get to the hospital, because a real threat arises for the baby's life and time goes by hours;
• with complete detachment of the child's place, it is possible to save the baby only if the pregnant woman is already in the hospital, because the fetus can live no more than 20 minutes without oxygen.

The location of the child's place and the gestational age are of great importance for preserving the life of the fetus. If the placenta is close to the exit from the uterus (placenta previa, low position), then the first manifestation of detachment will be profuse bleeding. When the baby is less than 28 weeks old, it will be very difficult for the fetus to survive due to the pronounced immaturity.

Conservative treatment

With a small detachment in favorable conditions (bleeding is insignificant, pain is not expressed, the fetus does not suffer, the degree of detachment does not increase), timely assistance will help maintain the pregnancy. In the hospital, the doctor will prescribe the following measures:

• the strictest bed rest;
• hormonal preservation therapy (morning or dyufaston);
• reducing the tone of the uterus with the help of antispasmodics and sedatives;
• effect on the vascular system to prevent thrombus formation in the small capillaries of the placenta;
• the use of drugs that improve blood flow in the placenta.

Operative treatment

In an unfavorable combination of circumstances (pronounced external bleeding, severe pain syndrome, increasing or complete detachment, a threat to the life of the fetus), the question of an urgent caesarean section will arise, the main purpose of which is to save the baby's life.

What will happen after the detachment

If everything went well and the pregnancy was saved, then the next step is to continue the treatment. As a rule, even with partial suffering, the baby needs help by providing the best conditions for growth and development. Optimal therapy will be provided at the perinatal center. At the next stage, it will be necessary to continue treatment with the antenatal clinic doctor in order to prevent recurrence of the detachment of the child's seat. It is necessary to exclude the factors due to which there was a detachment (exclude physical labor and stress, stop taking drugs that affect the tone of the uterus). The doctor will prescribe a conservative medication.

After discharge from the hospital, constant monitoring of the child's condition is needed. This will require an ultrasound scan as indicated and weekly. With the help of these studies, the doctor will notice in time the developmental lag in the baby or the occurrence of a violation of blood flow between the mother and the fetus.

You won't wish this trouble to the enemy, but if there is a detachment of the placenta, then only the quick help of professionals in a maternity hospital can save the baby. When, as a result of treatment, the detachment can be dealt with, careful attention to the doctor's recommendations and the prevention of pregnancy complications will allow the expectant mother to calmly inform and give birth to a healthy child.

thanks

Premature detachment of a normally located placenta is a condition, the main symptom of which is the untimely separation of the placenta from the uterine wall. This happens during pregnancy, or during childbirth, and not after the birth of the fetus, as it should be normal. Detachment in a general sense can be described as the separation of the placenta from the uterine mucosa, which is accompanied by damage to the blood vessels of the uterus and placenta, and, consequently, bleeding of varying severity. This pathology occurs, according to various sources, in 0.5% -1.5% of all pregnancies.

Normally, the placenta is separated from the uterus only in the third stage of labor. With the premature separation of the placenta from the wall of the uterus, which does not occur after the birth of the child, but even during pregnancy or at the very beginning of labor, the uteroplacental vessels are almost always seriously damaged. This process leads to the fact that the child is deprived of access to oxygen and nutrients - a condition called fetal hypoxia develops. In addition, placental abruption can be accompanied by massive bleeding, which poses a threat to the life of both the fetus and the mother. Also, exfoliation of the placenta increases the risk of disturbances in the physical development of the fetus, premature birth and death of the child in the womb. Unfortunately, according to statistics, it is placental abruption that is one of the most common causes of stillbirth and infant mortality.

Why does placental abruption occur?

Medical science has not yet been able to unambiguously identify the factor causing the development of placental abruption. It is believed that this disorder is multifactorial - that is, a combination of several predisposing factors often leads to its appearance.

At the moment, there are a number of reasons for premature placental abruption during pregnancy or childbirth:

• High blood pressure (hypertension) in the mother is considered one of the most significant factors.
• Placental abruption can be caused by sudden fluctuations in blood pressure arising from neuropsychic influences or stress. In addition, blood pressure can change when the inferior vena cava is compressed by the pregnant uterus. This condition can occur with prolonged supine position.
• The risk of placental abruption increases if the same pathology was observed during previous pregnancies.
• Frequent or multiple births - premature placental abruption is significantly more common in women who have given birth many times. This is associated with degenerative changes in the mucous membranes of the uterus.
• One of the predisposing factors for placental abruption is a post-term pregnancy.
• The age of the pregnant woman - with its increase, the risk of placental abruption also increases. In addition, in women over the age of 34, the formation of an additional lobule of the placenta is often observed. During childbirth, this additional lobule often comes off, which can lead to the development of detachment of the entire placenta.
• The chance of a placental abruption is increased if the pregnant woman has had at least one baby by caesarean section in the past.
• The risk of placental abruption increases if conception was preceded by a period of infertility.
• Preeclampsia, gestosis and toxicosis, especially in the first trimester of pregnancy, are one of the important factors. This is explained by the fact that gestosis is manifested by an increase in blood pressure, edema, and the appearance of protein in the urine. In addition, with gestosis, especially with their severe forms, it is the vessels that first of all suffer: they become brittle and fragile.
• Abnormalities in the structure of the uterus (two-horned or saddle uterus) can lead to placental abruption. In addition, an important factor is anomalies of the vessels located deep in the muscular layer of the uterus, changes in the vascular walls, an increase in their permeability, an increase in the fragility and fragility of capillaries caused by a loss of their elasticity, as well as a violation of their patency for blood.
• Anomalies in the location and maturation of the placenta itself during pregnancy can also lead to its rejection.
• A possible cause of placental abruption can be disorders of the blood coagulation system, often accompanying various pathologies of pregnancy.
• Placental abruption can also cause abnormalities in labor. For example, a rapid drop in pressure in the uterus. More often this happens with polyhydramnios at the time of opening the birth bladder, and the rapid outpouring of water. Sometimes it can be caused by the birth of the first fetus with multiple pregnancies. Also, this pathology can occur with rapid childbirth. If the umbilical cord is shorter than usual, or the fetal bladder opens with a delay, the placenta is pulled down by the unexploded membranes or short umbilical cord, which leads to its detachment.
• A blunt external trauma to the abdomen, for example, a blow, a fall on the abdomen, or a road accident, can lead to an acute condition and the occurrence of placental abruption.
• In the development of this pathology, factors such as tobacco smoking, the use of a large amount of alcoholic beverages, and also cocaine are involved. The situation is even more complicated with the development of anemic conditions: anemia, a decrease in the number of red blood cells, a decrease in hemoglobin.
• Placental abruption can result from an allergic reaction to drug therapy, transfusion of protein drugs or blood components. Occasionally, an autoimmune form of detachment occurs. In this case, the woman's body produces antibodies to its own tissues, and rejects them. This happens more often with extensive systemic diseases such as rheumatism or systemic lupus erythematosus.
• Placental abruption can be caused by diabetes mellitus and other hereditary and chronic diseases, infectious inflammations (for example, pyelonephritis), neoplastic processes, obesity, thyroid diseases, pathologies of the blood and hematopoietic system, etc. This is explained by the fact that the course of all these diseases can be quite complicated and aggravated during pregnancy, which in itself is a serious test for the female body.

What are the symptoms of premature placental abruption?

Pathological changes that are associated with placental abruption are primarily in the appearance of bleeding that occurs due to damage to the uteroplacental vessels. Due to the fact that the placenta begins to separate, there is an accumulation of blood between the wall of the uterus and the placenta, and a hematoma is formed. Gradually increasing, the hematoma increases the detachment of placental tissue from the uterine wall, and as a result, it leads to compression and termination of the functioning of the placenta, which is adjacent to this site.

Experts identify mild, moderate and severe forms of premature placental abruption:
1. Light form is often not associated with any distinct symptoms, and placental abruption is detected only with ultrasound examinations, or after childbirth, when a small depression filled with dark blood clots is found on the maternal surface of the placenta.
2. Pathology of moderate severity manifested by abdominal pain and minor bleeding from the genital tract. Sometimes external bleeding may be completely absent. It depends on the size of the hematoma and the location of the disorder. When palpating, a somewhat tense uterus is revealed, sometimes moderate local pain is noted. When listening, cardiac abnormalities in the fetus can be determined, which indicate its hypoxia.

3. Severe form placental abruption is manifested by sudden severe bursting pain in the abdomen, dizziness, severe weakness, anxiety. Fainting may sometimes occur. Sweating, shortness of breath, increased heart rate, decreased body temperature and blood pressure may occur. There is also a pronounced pallor of the skin. The characteristic appearance of dark spotting from the genital tract in moderate amounts. During examination, the uterus is very tense and has an asymmetric shape: on the one hand, a protrusion is determined, which is very painful when palpating. In some cases, for example, with existing scars or dystrophic changes in the uterine wall, it may rupture. Fetal body parts are not palpated, and its heartbeat is not heard.

The classic clinical triad of signs of premature placental abruption is bleeding from the genital tract, pain and tension in the uterus, and fetal heart failure.

Uterine bleeding

In four cases out of five, vaginal bleeding is observed with placental abruption. It can have varying degrees of intensity: abundant, insignificant, or completely absent. It depends on the place of placental abruption, the area of ​​the pathological process and the general state of the blood coagulation system.

Sometimes blood accumulates in the uterus behind the separated part of the placenta, which means that no bleeding may be observed. This most often occurs with central placental abruption, and is considered the most dangerous form of this pathology. Bleeding from damaged vessels does not stop, but has the character of internal or latent. The blood is located between the uterus and the placenta - a retroplacental hematoma occurs. The placenta exfoliates in its central part, and its edges remain connected to the uterine wall. With a significant area of ​​detachment, extensive retroplacental hematoma and profuse bleeding, the outflowing blood soaks the wall of the uterus. This leads to a violation of her contractile abilities, up to their complete loss. In addition, it is associated with massive blood loss during childbirth. This state was named Couveler's uterus by the name of the author who first described this picture. In such cases, we are already talking about saving the woman's life, therefore, the dead fetus is usually urgently removed along with the uterus.

With marginal or partial placental abruption, bleeding can be visible or external. External bleeding is most often secondary, and not so profuse. It is believed that its appearance can prevent the further development of placental abruption. This is due to the fact that if the area of ​​the placental abruption is small, then after the appearance of a retroplacental hematoma, thrombosis of the damaged uterine vessels occurs, leading to a stop of further detachment. Scarlet blood escaping from the vagina indicates that placental abruption has just occurred. If the bloody discharge is dark in color, and the presence of clots is noted in them, this means that some time has passed between placental abruption and the onset of bleeding.

Mixed (internal-external) bleeding may also occur. In this case, there is both latent and visible discharge of blood. With premature detachment of a normally located placenta, it is almost impossible to accurately determine the volume of blood lost. Usually, the amount of external bleeding is assessed, and clinicians are guided by the general condition of the woman and the reaction of her body to blood loss: changes in pulse, pressure, etc. It must be remembered that the absence of bloody discharge during placental abruption cannot be regarded as the absence of symptoms, since it can be completely hidden.

Abdominal pain and uterine tension

With premature placental abruption, in the overwhelming majority of cases, there is a pain syndrome. This pain is often characterized as dull, often has a paroxysmal form, can radiate to the thigh, perineum or lumbar region. When palpating, the uterus is painful, while the pain can be strictly local, or it can be diffuse. Pain will usually be more severe if there is internal bleeding. In connection with the formation of a retroplacental hematoma, a local swelling forms, stretching the uterine wall, and a rapidly increasing pain arises, which gradually spreads to the rest of the uterus. Also, when palpating, the tension of the uterus is determined, and its dense consistency is noted.

Violation of the heart in the fetus

This condition progresses in proportion to an increase in the area of ​​placental abruption and an increase in the volume of blood loss in the mother. Listening to this symptom indicates the development of fetal hypoxia. Its signs appear with detachment of more than a quarter of the total area of ​​the placenta. If the pathological process covers a third of the total area of ​​the placenta, then the fetus is already experiencing a threatening oxygen deficiency. And the detachment of more than half of the area of ​​the placenta in most cases leads to intrauterine fetal death.

Placental abruption at different stages of pregnancy

Placental abruption has different clinical manifestations depending on the gestational age at which it occurred.

Premature placental abruption in the early stages

Placental abruption in the first trimester is quite common, but with timely diagnosis and treatment, it can be prevented in most cases. Most often, a retroplacental hematoma is formed, which is clearly visible during ultrasound. In this case, there will be no selection. Provided that the preserving pregnancy and hemostatic therapy are prescribed in a timely manner, the pregnancy will continue to develop normally. The placenta, which continues to grow, over time is able to fully compensate for the lost area of ​​contact with the uterine wall, and the transferred complication will not affect the health of the unborn child in any way.

Placental abruption in the second trimester

With placental abruption in the period from 12 to 27 weeks of pregnancy, tension and high muscle tone of the uterus are also added to the symptoms described above. If fetal hypoxia begins, then with a lack of oxygen, the child can activate his movements in the womb to accelerate blood flow, and hence the supply of fresh oxygen with blood. During this period, much depends on the specific duration of pregnancy, since the placenta is able to continue its growth until the middle of the second trimester, and due to this, it can compensate for the lost area of ​​contact with the uterus. At a later date, the question of an emergency caesarean section is raised, which is necessary to prevent fetal death from progressive hypoxia.

Placental abruption in later stages

The most dangerous placental abruption is in the third trimester of pregnancy. The placenta no longer has the ability to grow, which means that all of its compensatory capabilities have already been exhausted. In such a situation, immediate delivery is indicated for health reasons. But it should be noted that non-progressive partial placental abruption in the absence of bleeding sometimes makes it possible to deliver pregnancy in a hospital setting and under close medical supervision.

Placental abruption during labor

With polyhydramnios or multiple pregnancies, placental abruption can occur directly during childbirth. In such cases, depending on the stage of labor, either they are stimulated (up to the use of forceps), or, if labor is absent, they proceed to delivery by cesarean section. At the first stage of labor, premature detachment is most often manifested by bloody discharge with clots. At the same time, with external bleeding during contractions, the release of blood does not increase, but, on the contrary, stops. There is a pathological tension in the uterus, it does not relax completely between contractions. With vaginal examinations, the tension of the fetal bladder is also determined, and when it is opened, the effusion of the fetal waters is colored with blood. Signs of fetal disorders may be observed: an increase or decrease in its heartbeat, and in the amniotic fluid, in addition to blood, impurities of meconium - primary feces may appear. Often, the appearance of these symptoms is the only sign of the onset of premature placental abruption in the second stage of labor.

Remember that even a minimal placental abruption is a reason for immediate hospitalization and initiation of conservation therapy!

It is necessary to urgently consult a doctor, or even immediately go to the hospital, if the following symptoms appear:

• vaginal bleeding or discharge;
• uterine pain, pain in the lower abdomen or in the back;
• very frequent or long-term contractions;
• lack of movement of the child in the womb.

Diagnosis of placental abruption

Diagnosis of this pathology is usually straightforward. Its clinical manifestations are most often extremely unambiguous, and in difficult cases they resort to the use of ultrasound. Diagnostics is based, first of all, on the identification of bleeding from the genital tract during childbirth or during pregnancy. This is usually accompanied by an increase in tone and a change in the shape of the uterus, as well as abdominal pain in combination with signs of progressive oxygen deficiency of the fetus. When diagnosing, the patient's complaints, data from her medical history, as well as the results of objective, instrumental and laboratory examinations are taken into account.

The doctor measures the fetal heart rate and performs an ultrasound scan. With the help of ultrasound, it is possible to unambiguously confirm the presence of placental abruption, determine its area, as well as the volume and location of the retroplacental hematoma. A very small placental abruption on an ultrasound scan may not be diagnosed, but often this examination is able to determine the presence of blood clots behind the placenta. This helps distinguish between placental abruption and placental presentation, another common cause of bleeding.

Because the bleeding may not be uterine, the doctor examines the vagina and cervix to determine if the bleeding is caused by an infection, a ruptured cervix, polyps (benign growths) on the cervix, or something else. The doctor will also assess for any dilatation of the cervix, which could damage small blood vessels and cause bleeding.

From the point of view of diagnosis, there are 3 types of placental abruption:
1. Partial non-progressive Premature placental abruption begins in a small area after the formation of a hematoma. In such cases, blockage of damaged blood vessels often occurs, bleeding stops and the progression of detachment. Pregnancy and childbirth can go completely normal. A minor and non-progressive placental abruption may not manifest itself clinically at all, and it is recognized only after delivery. In the process of examining the maternal surface of the placenta, after its birth, a small blood clot of dark red color or a slight depression is found.

2. With partial progressive the process of placental abruption develops, the hematoma increases in size, and the course of pregnancy and subsequent childbirth becomes pathological. Detachment of one quarter of the total area of ​​the placenta is considered dangerous for the fetus. With an increase in the area of ​​detachment to one third, severe fetal hypoxia develops, there is a threat of intrauterine death. With the detachment of half of the area of ​​contact of the placenta with the uterine wall, this outcome becomes almost inevitable. Of course, in such conditions, a pregnant woman suffers greatly. Bleeding from damaged vessels of the exfoliated part of the placenta is constant, which means that a woman loses a lot of blood. The consequences of massive blood loss gradually increase up to the development of hemorrhagic shock. Often, it is possible to cope with the situation only by resorting to urgent delivery.

3. In rare cases, there is complete or total placental abruption over the entire area of ​​contact with the wall of the uterus. In such situations, almost immediate death of the fetus occurs, since any gas exchange between the mother's body and the fetus completely stops.

What to do with placental abruption?

If the expected date of delivery is not far off, then it is necessary to give birth immediately, even if the detachment is insignificant. The process can begin to progress at any time, and this can threaten the loss of the child. In most of these cases, delivery is done by caesarean section. But if the bleeding is not very profuse and, according to the doctor and the ultrasound data, it is caused by a detachment that is quite small in area, and the child and you feel normal, you may be allowed to give birth naturally.

If the doctor diagnosed a small placental abruption, but the baby is still premature, and no further bleeding is observed, then labor should be postponed. In this case, together with your doctor, you need to weigh the ratio of the risk of premature birth and the risk of progression of detachment. You need to stay in the hospital to be under constant supervision of specialists. This will allow doctors to start labor right away if the detachment worsens, or if the baby or you feel worsening.

Treatment of premature placental abruption

Therapy for premature detachment of a normally located placenta is based on choosing the method of the fastest and most gentle delivery. In addition, it is necessary to simultaneously carry out activities aimed at combating blood loss, shock, as well as replenishing factors that increase blood clotting.

Obstetric tactics when choosing a method of delivery will be determined by three parameters:
1. The time of the detachment - whether it happened during pregnancy, or already in childbirth.
2. The severity of bleeding and the amount of blood loss.
3. The general condition of the mother and fetus.

Prolongation of pregnancy in a hospital setting is possible, but only if the following conditions are met:

• placental abruption is partial, small in area and does not progress;
• pregnancy is less than 36 weeks;
• both the pregnant woman and the fetus feel good, and there are no signs of oxygen starvation of the fetus;
• the total amount of bleeding is small.

In this case, it is necessary to carefully monitor the state of the placenta and the fetus. For this purpose, it is necessary to regularly conduct an ultrasound examination, dopplerometry and cardiotocography ... It is also necessary to carefully monitor the state of the woman's blood coagulation system using laboratory tests. The patient is assigned to bed rest.

In addition, the following drugs are used in the treatment of placental abruption:

• medications that relax the uterus (tocolytic therapy);
• antispasmodics (papaverine, no-shpa, magnesium sulfate, metacin, etc.);
• hemostatic agents (ascorbic acid, vicasol, decinone);
• therapy aimed at combating anemia (iron supplements).

Therapy of concomitant diseases and complications must be carried out without fail.

If, in the hospital, there are repeated, even the most insignificant, bleeding, which indicates the progression of detachment, then wait-and-see tactics should be abandoned even if the patient is in a satisfactory condition. In such cases, the issue is usually decided in favor of using an emergency caesarean section. The basis for surgical intervention are vital indications from both the fetus and the mother. If the woman's birth canal is already mature (the cervix is ​​softened and shortened, and the cervical canal is passable), then an artificial opening of the fetal bladder is performed, and it becomes possible to carry on labor through the natural birth canal. But in most of these situations, emergency delivery still takes place by caesarean section.

If the pregnancy is full-term, and the area of ​​placental abruption is small, then the question of natural delivery is raised immediately. The presence of a mature birth canal eases the situation - at the first stage of labor, the fetal bladder is opened. This causes a decrease in intrauterine pressure, which prevents further placental abruption.

In any case, childbirth should be carried out under close supervision of the cardiac activity of the fetus, as well as the contractile activity of the uterus. In case of increased bloody discharge, deterioration of the fetus, an increase in the tone of the uterus in the intervals between contractions or deterioration of the mother's condition, they urgently switch to a cesarean section. If the birth took place naturally, then immediately after the birth of the child, it is imperative to conduct a manual examination of the uterine cavity. In the sequential and early postpartum periods, prevention of bleeding is used with the use of drugs that increase uterine contractions (oxytocin, prostaglandins, methylergometrine).

Simultaneously with delivery (by natural childbirth or cesarean section), the following activities are carried out:

• restoration of the volume of lost blood;
• combating the manifestations of shock (maintaining the functions of the respiratory and cardiovascular systems, pain relief, etc.);
• antianemic therapy;
• restoration of blood clotting disorders by transfusion of fresh donor blood or its preparations (fibrinogen, fresh frozen plasma, platelet mass, etc.).

If premature placental abruption progresses, has a severe course, and it is impossible to perform urgent delivery through the vaginal birth canal, then it is necessary without hesitation to immediately proceed to an emergency caesarean section. When performing this operation, you need to free the uterine cavity from blood and clots immediately after removing the fetus and placenta. Next, the doctor must carefully examine all the uterine walls in order to assess the condition of the muscle layer. If the muscles of the uterus are already soaked in blood, then the uterus is removed, as it will become a source of further bleeding.

Pregnancy after placental abruption

Many women who have had placental abruption during a previous pregnancy are wondering: how to avoid recurrence of this complication in the next pregnancy?

The percentage of placental abruption relapses in subsequent pregnancies is very high. The frequency of such cases ranges from 5 to 17%. In a situation where a woman has had placental abruption during two previous pregnancies, the chance of her recurrence is about 25%. Unfortunately, at the moment, a treatment regimen has not yet been developed that would prevent placental abruption during the next pregnancy, or at least be able to reduce the percentage of relapses.

What is the threat of placental abruption, and is it possible to somehow prevent it?

Depending on the area of ​​the detachment, the severity of blood loss and the severity of the course of the process, this complication can either resolve imperceptibly or pose a serious threat to the life of the fetus and mother.

The best method for preventing this pathology will be to determine all possible risk factors at the very early stages of pregnancy, and to take all available measures to eliminate them.

• Monitor your blood pressure. If you have hypertension, try to carry out the most effective therapy for it. Your doctor will prescribe blood pressure medications that are safe for your baby.
• Be sure to attend all routine check-ups in the antenatal clinic. Get ultrasound examinations periodically.
• If you have a negative Rh factor, and the father of the child is positive, and in the second or third trimester of pregnancy you had vaginal bleeding, then you need to inject anti-D immunoglobulin to prevent the development of Rh-conflict.
• Don't smoke, don't use drugs, and limit your alcohol intake.
• Strictly observe all safety requirements, be sure to fasten your seat belt in the car. The cause of the onset of placental abruption can be the most insignificant at first glance injuries.
• In the event of complications or exacerbation of chronic diseases, it is necessary to begin their treatment as soon as possible. Specialists pay special attention to pregnant women with late toxicosis. At 36-38 weeks of pregnancy, patients with a similar complication should be admitted to the hospital without fail.

Prevention of placental abruption

Among the most significant preventive measures that are aimed at preventing premature placental abruption are the following:

• thorough professional examination, diagnosis and therapy of inflammatory, degenerative and any other pathological processes in the uterus and pelvic area with mandatory monitoring of the effectiveness of treatment;

Reading time: 9 minutes

Of great importance is the organ that occurs during pregnancy in the uterine cavity and connects the organisms of the mother and the fetus. The placenta is responsible for the biological processes of the child, thanks to which he is able to develop normally in the tummy. The health and life of the baby depends on this organ, therefore, placental abruption at an early or late stage of pregnancy is considered a dangerous phenomenon, the diagnosis and treatment of which is best done as early as possible.

What is placental abruption

The condition, the main symptom of which is the untimely rejection of the child's place from the uterine membrane, is called premature placental detachment. Pathology can develop both during pregnancy and during labor. Normally, the placenta is separated only after the baby is born. Premature detachments are accompanied by damage to blood vessels, which causes uterine bleeding of varying severity. A dangerous complication occurs in 0.5-1.5% of pregnancy cases and, according to statistics, develops more often in primiparous women.

Pathology, as a rule, develops during premature birth and always requires urgent medical intervention. The state of the child's place determines the normal development of the fetus or its death. Normally, the organ is located on the uterine wall in the upper part of the body of the uterus (at the front and back walls or at the bottom), otherwise placenta previa is diagnosed - its incorrect location. On the one hand, the uterine muscles press on the afterbirth, on the other, the fetus and amniotic fluid. Normally, the balance of pressure prevents premature detachment of the organ.

Symptoms

The pathological process is accompanied by bleeding resulting from damage to the uterine and placental vessels. As a result, the afterbirth begins to separate, the blood between it and the wall of the uterus accumulates and a hematoma is formed. Gradually, it increases in size and causes the progression of detachment, which entails compression and dysfunction of the organ. Doctors distinguish three degrees of severity of premature placental abruption, each of which is characterized by certain symptoms:

1. The mild form, as a rule, does not have clear signs, therefore, the pathology can only be diagnosed during a planned ultrasound scan or after childbirth, when a small deformation (depression) filled with blood clots is found on the surface of the bladder.
2. Signs of moderate placental abruption are characterized by abdominal pain and small bleeding from the genital tract. In some cases, external bleeding is absent altogether, depending on the size of the hematoma and the localization of the site of violation. Palpation reveals a slightly tense uterus, sometimes moderate soreness.
3. A severe form of detachment is characterized by sudden intense pain in the peritoneum, severe weakness, dizziness, and anxiety. Sometimes women experience a fainting state, possibly increased sweating, a decrease in body temperature and blood pressure, and an increase in heart rate. In addition, as a rule, pallor of the skin and the appearance of dark spotting from the vagina are noted. During examination, the uterus is tense and has an asymmetric shape (there is a protrusion on either side, when this area is pressed, pain occurs). Fetal body parts are not palpated, and the heartbeat is not heard.

Placental abruption reasons

It is extremely difficult to determine which factor caused the partial or total detachment of the child's place. It is believed that this pathology occurs due to the presence of several negative aspects and predisposing factors. To date, doctors identify the following possible reasons for the detachment of the placenta during pregnancy and childbirth:

• hypertension in the mother, strong fluctuations in blood pressure during stress and neuropsychic influences (sometimes pressure changes occur due to compression of the inferior vena cava by the uterus, which occurs with prolonged lying on the back);
• pathology has already been observed in a previous pregnancy (while the risk of premature rejection of the placental bladder is increasing);
• multiple or frequent childbirth (detachment is observed in women who have given birth several times, which is associated with changes in the mucous membrane of the uterus);
• post-term pregnancy;
• the age of the pregnant woman (the older the woman, the higher the risk of pathology);
• period of infertility before conception;
• toxicosis, gestoch, preeclampsia, especially in the first trimester of the term;
• anomalies in the structure of the uterus;
• vascular diseases located deep in the muscular layer of the uterus, changes in the walls of blood vessels, an increase in their permeability, impaired blood permeability;
• anomalies of maturation and location of the placenta;
• violation of blood clotting;
• pathology of labor (a rapid decrease in pressure in the uterus, which, as a rule, occurs when the birth bladder is opened or the rapid outpouring of water);
• fast delivery;
• late opening of the fetal bladder;
• short umbilical cord;
• blunt external trauma to the abdomen (due to a fall, impact, etc.);
• bad habits, dependence (drinking alcohol, smoking, taking drugs);
• anemia, a decrease in hemoglobin levels, the number of erythrocytes;
• an allergic reaction to medicines, transfusion of blood components or protein preparations;
• autoimmune factors (occasionally the female body produces antibodies to tissues, after which they begin to be rejected; as a rule, this occurs in the presence of systemic diseases such as rheumatism or lupus);
• diabetes mellitus, other hereditary, infectious or chronic diseases;
• obesity, the presence of tumors, etc.

Manifestation at different stages of pregnancy

Detachment of the placental sac is the process of its separation from the uterine wall, while complete and partial detachment is isolated. In the course of the pathological process, blood accumulates between the fetus and the walls of the uterus, which repels the afterbirth. This process is natural and occurs in the last trimester of pregnancy, however, under the influence of various negative factors, detachment can occur ahead of time.

Detachment of the placenta in the early stages

In the first trimester, the pathological process is diagnosed relatively often, but with timely detection and treatment, negative consequences can be prevented. As a rule, the cause of the detachment of the placenta is a retroplacental hematoma, which is visible on ultrasound examination. Detachment of the placenta in early pregnancy is not accompanied by discharge. With adequate and timely therapy, there is no threat to the mother or baby. The placenta, which continues to grow, gradually compensates for the lost area and the complication does not affect the child's health.

In the second trimester

Placental abruption from 13 to 26 weeks of pregnancy is characterized by tension and high tone of the muscles of the uterus. At the onset of fetal hypoxia, the baby can begin to move more actively in the intrauterine bladder, which stimulates the acceleration of blood flow and, as a result, the supply of fresh oxygen. At this time, the positive outcome of the pathology depends on the duration of pregnancy, since the placenta is able to continue to grow until the middle of the second trimester, thereby compensating for the area of ​​contact with the uterus. In the later stages, the question arises of an emergency caesarean section.

Placental abruption in late pregnancy

The most dangerous is the premature detachment of the normally located placenta in the third trimester of the term. This is due to the fact that the organ is no longer growing, therefore, its compensatory capabilities are absent. In this case, the patients are shown operative delivery according to vital signs. Nevertheless, progressive partial placental abruption with little or no bleeding sometimes makes it possible to deliver the fetus in a hospital setting and under medical supervision.

During childbirth

Pregnancy complications such as polyhydramnios or multiple pregnancies increase the risk of detachment of the baby's seat during labor. In this case, depending on the stage of childbirth, the doctor decides on their stimulation (up to the use of forceps) or, if labor is absent at all, a cesarean section is performed. At the first stage, premature detachment is usually manifested by bloody discharge with clots. With external bleeding during contractions, blood loss does not increase, but stops.

In women with placental abruption during labor, there is a tension in the uterus that does not ease between contractions. When examining the vagina, the doctor determines the tension of the fetal bladder, upon opening which, blood-stained fetal waters are found. In addition, there may be signs of fetal disruption, for example, a slowdown or increased heart rate. In the amniotic fluid, an admixture of meconium (primary feces) is sometimes found. Such symptoms are evidence of premature placental abruption in the second stage of labor.

Diagnosis of placental abruption

If symptoms of marginal or central detachment are present, an examination is performed to confirm the diagnosis. The main method is ultrasound, thanks to which it is possible to establish the area of ​​the part of the placenta that has moved away from the uterine wall and the size of the retroplacental hematoma. In addition, blood tests and gynecological examinations are performed. It is important in the diagnostic process to establish the condition of the fetus, whether it is alive. During the examination, the doctor can establish one of 3 possible diagnoses:

• progressive partial (uterine vessels burst, the size of the hematoma gradually increases, as a result of which the woman loses a lot of blood, which can lead to hemorrhagic shock; in this case, urgent delivery is indicated);
• non-progressive partial (minor marginal detachments are often accompanied by blockage of blood vessels, as a result of which bleeding stops, as well as further separation of the baby's place from the uterine wall; at the same time, pregnancy can proceed normally, and the child is born healthy);
• total detachment (the prognosis is disappointing - the fetus dies almost immediately, since gas exchange between it and the mother stops).

How to treat a detachment

If a premature rejection of the placenta is detected, the doctor is faced with the task of choosing a suitable method of treatment aimed at increasing blood clotting, combating blood loss, and shock. Therapy for placental abruption in the early and later stages of pregnancy depends on the following factors:

• time of development of pathology;
• the volume of blood loss, the intensity of bleeding;
• the general health of the baby and mother.

The doctor may refuse the option of operative delivery if:

• a small area of ​​the placenta has exfoliated and this condition does not progress;
• the term is no more than 36 weeks;
• there are no signs of hypoxia in the child;
• the discharge has stopped, the volume of blood loss is insignificant;
• the woman feels well and is under the supervision of doctors in a hospital setting.

The patient with the detachment of the placenta must comply with bed rest, while her state of health is subject to constant medical supervision. You should regularly undergo ultrasound, dopplerometry, cardiotocography, monitor blood coagulation, which is determined through laboratory tests. With placental detachment, the following drugs can be prescribed:

• hemostatic agents;
• antispasmodics;
• medications that relax the uterus;
• hormones;
• remedies for the treatment of anemia.

Consequences for the child

Premature placental abruption is a common cause of stillbirth in the last weeks of pregnancy. About 15% of children die from this pathology. The cause of death is serious disorders that the fetus faces as a result of the detachment of the placenta. These include hypoxia (oxygen deficiency) and other problems caused by prematurity in the event of premature labor. The consequence of pathology is often neurological disorders and developmental lag in the child.

Preventive measures

There are no methods that are guaranteed to help the normal attachment of the placenta during conception. The causes of placental abruption are difficult to determine, so you can only try to reduce the risk of pathology by using the following measures:

• when planning a pregnancy, a woman is recommended to undergo a full examination, which will check her fertility, the presence of any diseases and infections in the body, which are treated before pregnancy;
• during gestation, you need to regularly undergo examinations, visit a doctor;
• any medications are allowed to be taken only with the consent of the doctor;
• a pregnant woman needs to avoid injuries, give up bad habits, monitor her own health;
• a woman is advised to regularly walk in the fresh air, eat right, and avoid stress.

Video